Insurance Carrier	Facility/Professional	Modifier	Low Price	Median Price	High Price
Aetna Facility/Professional Facility Modifier 26 Low / Median / High Price $70.81 / $87.88 / $126.00	Facility	26	$70.81	$87.88	$126.00
Aetna Facility/Professional Professional Modifier Low / Median / High Price $195.68 / $402.08 / $1,222.20	Professional		$195.68	$402.08	$1,222.20
Aetna Facility/Professional Professional Modifier 26 Low / Median / High Price $70.81 / $126.00 / $276.00	Professional	26	$70.81	$126.00	$276.00
Aetna Facility/Professional Professional Modifier 52 Low / Median / High Price $97.84 / $144.35 / $315.73	Professional	52	$97.84	$144.35	$315.73
Aetna Facility/Professional Professional Modifier TC Low / Median / High Price $124.85 / $259.35 / $458.71	Professional	TC	$124.85	$259.35	$458.71
Ambetter Facility/Professional Professional Modifier Low / Median / High Price $144.61 / $308.89 / $993.96	Professional		$144.61	$308.89	$993.96
Ambetter Facility/Professional Professional Modifier 26 Low / Median / High Price $52.44 / $94.04 / $147.49	Professional	26	$52.44	$94.04	$147.49
Ambetter Facility/Professional Professional Modifier TC Low / Median / High Price $187.15 / $187.15 / $649.35	Professional	TC	$187.15	$187.15	$649.35
BCBS Facility/Professional Professional Modifier Low / Median / High Price $200.02 / $200.02 / $200.02	Professional		$200.02	$200.02	$200.02
BCBS Facility/Professional Professional Modifier 26 Low / Median / High Price $126.06 / $185.71 / $216.18	Professional	26	$126.06	$185.71	$216.18
BCBS Facility/Professional Professional Modifier TC Low / Median / High Price $398.29 / $611.96 / $892.95	Professional	TC	$398.29	$611.96	$892.95
Cigna Facility/Professional Facility Modifier 26 Low / Median / High Price $80.26 / $80.26 / $80.26	Facility	26	$80.26	$80.26	$80.26
Cigna Facility/Professional Professional Modifier Low / Median / High Price $256.33 / $538.11 / $1,130.38	Professional		$256.33	$538.11	$1,130.38
Cigna Facility/Professional Professional Modifier 26 Low / Median / High Price $73.30 / $121.11 / $211.39	Professional	26	$73.30	$121.11	$211.39
Cigna Facility/Professional Professional Modifier TC Low / Median / High Price $161.35 / $382.28 / $946.32	Professional	TC	$161.35	$382.28	$946.32
Medcost Facility/Professional Facility Modifier 26 Low / Median / High Price $115.46 / $164.30 / $275.00	Facility	26	$115.46	$164.30	$275.00
Medcost Facility/Professional Professional Modifier Low / Median / High Price $94.00 / $186.00 / $450.00	Professional		$94.00	$186.00	$450.00
Medcost Facility/Professional Professional Modifier 26 Low / Median / High Price $115.46 / $115.46 / $260.64	Professional	26	$115.46	$115.46	$260.64
Oscar Health Facility/Professional Professional Modifier Low / Median / High Price $72.02 / $182.46 / $326.58	Professional		$72.02	$182.46	$326.58
United Facility/Professional Professional Modifier Low / Median / High Price $209.48 / $405.72 / $647.41	Professional		$209.48	$405.72	$647.41
United Facility/Professional Professional Modifier 26 Low / Median / High Price $73.87 / $101.02 / $210.85	Professional	26	$73.87	$101.02	$210.85
United Facility/Professional Professional Modifier TC Low / Median / High Price $134.72 / $259.85 / $535.53	Professional	TC	$134.72	$259.85	$535.53
Wellcare Facility/Professional Facility Modifier 26 Low / Median / High Price $510.16 / $641.91 / $641.91	Facility	26	$510.16	$641.91	$641.91
Wellcare Facility/Professional Professional Modifier Low / Median / High Price $2,988.88 / $2,988.88 / $2,988.88	Professional		$2,988.88	$2,988.88	$2,988.88
Wellcare Facility/Professional Professional Modifier 26 Low / Median / High Price $558.07 / $558.07 / $563.25	Professional	26	$558.07	$558.07	$563.25
Wellcare Facility/Professional Professional Modifier TC Low / Median / High Price $2,573.94 / $2,573.94 / $2,573.94	Professional	TC	$2,573.94	$2,573.94	$2,573.94